FECALYSIS Flashcards
Around ______ grams of stool is passed per day
100-200 g
Color stool with upper GI bleeding, iron, charcoal, and bismuth
Black
“Melena”
Black stool
Stool color with Lower GI bleeding
Red
“Hematochezia”
Red stool
Stool color with bile duct obstruction, barium sulfate
Pale yellow, white, gray (alcoholic)
Stool appearance with Pancreatic disorders
FROTHY/bulky
Stool appearance with intestinal obstruction
Slender, ribbon/NOODLE-LIKE
Stool appearance with cholera
Rice watery
Stool appearance with typhoid
Pea soup
BRISTOL STOOL CHART: Separate hard lumps like nuts (hard to pass)
Type 1
BRISTOL STOOL CHART: sausage shaped but lumpy
Type 2
BRISTOL STOOL CHART: sausage like but with cracks
Type 3
BRISTOL STOOL CHART: sausage like or snake, smooth and soft
Type 4
BRISTOL STOOL CHART: soft blob with clear cut edges (passed easily)
Type 5
BRISTOL STOOL CHART:
Fluffy pieces with ragged edges, a mushy stool
Type 6
BRISTOL STOOL CHART: watery, no solid pieces, entirely liquid
Type 7
Increased fats in stool
Steatorrhea
Increased fats in stool per day _____ grams
> 6 grams
Definitive test for steatorrhea
Fecal fat. Determination
Neutral fat stain - stain what fat
Triglycerides
What is added to stool suspension in neutral fat stain
95% ethanol + Sudan III
Stain color of fat droplets in neutral fat stain and spit fat stain
Orange droplets
Amount of fat droplets indicative of steatorrhea
60 or more droplets/HPF
Split fat stain —- stain what fat
Fatty acids
What is being added to emulsified stool in split fat stain
36% acetic acid + Sudan III
quantitative fecal fat tests
Van de Kramer titration
Acid steatocrit
Hydrogen nuclear magnetic resonance spectroscopy
Gold standard for fecal fat determination
Van de Kramer
For definitive diagnosis of steatorrhea
Van de Kramer titration
A quantitative fecal fat test that involves the titration of NaOH
Van de Kramer titration
Rapid test to estimate the amount of fat excretion (similar to microhematocrit test)
Acid steatocrit
A quantitative fecal fat test in which sample is microwaved dried and analyzed
Hydrogen nuclear magnetic resonance spectroscopy
Abnormal excretion of muscle fibers in feces
Creatorrhea
This is added to emulsified stool for creatorrhea determination
10% eosin
MUSCLE FIBER: Completely digested
No striations
MUSCLE FIBER: striations in one direction
Partially digested
MUSCLE FIBER: striations in both directions
Undigested
Count of Undigested muscle fibers considered abnormal
> 10
> 10 Undigested muscle fibers are seen in what conditions
Biliary obstruction
Cystic fibrosis
Neutrophil count in invasive condition
3 or greater neutrophil/HPF
Diarrheal bacteria with WBCs
Salmonella and shigella
Yersinia
Enteroinvasive E. coli
Campylobacter
Diarrhea without WBCs
Toxin producing (S. Aureus, VIBRIO CHOLERAE), virus, parasites
Fecal leukocyte determination that involves agglutination
Lactoferrin agglutination test
Found in secondary granules of neutrophils
Lactoferrin
Positive for lactoferrin agglutination test is indicative of
Invasive bacterial pathogen
Most frequently performed fecal analysis
Guiac fecal occult blood test (gFOBT)
A screening test for colorectal cancer
GFOBT
Sample for gFOBT
Center portion of the stool
gFOBT principle
Pseudoperoxidase activity of hemoglobin
Positive result color of gFOBT
Oxidized Guiac blue
Most sensitive chromogen for FOBT
Benzidine
Preferred chromogen for FOBT
Guiac
What should be avoided to avoid false negative FOBT
VITAMIN C
Iron supplements containing vit c
These are avoided for 7 days to avoid false positive FOBT
Aspirin
NSAIDs other than paracetamol
Other FOBT test that uses anti hemoglobin antibodies ; more sensitive to globin
Immunochemical
other FOBT that involves conversion of heme to fluorescent porphyrins
Porphyrin-based
Bloody stools and vomitus are sometimes seen in neonates as a result of swallowing maternal blood during delivery
Apt-Downey test
It is added to emulsified stool after centrifugation in Apt-Downey Test
1% NaOH
Apt test positive result : Pink solution
Pink solution = fetal blood
Apt test positive result : Yellow brown Supernatant
Maternal blood
Apt test: denatured by NaOH
Maternal blood
Apt test: alkaline resistant
Fetal blood
A fecal screening test that detects pancreatic enzyme called trypsin
X-ray film test (Gelatin Test)
X-ray film test : when _____ is present in stool, it digest _____ on the X-ray film, living clear area
Trypsin ; gelatin
X-ray film test: clearing of film
+ trypsin
Absence of trypsin is seen in what condition
Cystic fibrosis
Most valuable screening fecal test in assessing cases of infant diarrhea
Fecal carbohydrates
Tests for fecal carbohydrates (2)
Clinitest
Fecal pH
Clinitest of >0.5 g/dL is indicative of
Carbohydrate intolerance
Normal stool pH
7.0-8.0
Stool pH in carbohydrate disorder
<5.5 pH
Fecal screening test involving immunoassay using an ELISA test
Elastase-1
Fecal screening test that is a sensitive indicator of exocrine pancreatic insufficiency
Elastase-1
_____ a pentose that is absorbed without the help of pancreatic enzymes and is not metabolized
D-xylose
A fecal screening test that differentiates malabsorption and maldigestion
D-xylose test
Specimen for D-xylose test
2 hour post prandial blood
5hour urine
Low urine D-xylose
Malabsorption
Normal urine D-xylose
Maldigestion
In diarrhea, Stool weight _______ with increased liquidity and frequency of >3x/day
> 200 g/day
Duration of acute diarrhea
<4 weeks
Duration of chronic diarrhea
> 4 weeks
Major mechanism of diarrhea
Secretory
Osmotic
Altered motility
Lab tests used to differentiate secretory, osmotic, and altered motility :
Fecal electrolytes (sodium potasssium)
Fecal osmolarity
Fecal pH
Normal fecal osmolarity
290 mOsm/kg
Normal fecal sodium level
30 mmol/L
Normal fecal potassium level
75 mmol/L
Increased secretion of water electrolytes which override the reabsorptive ability of the large intestine
Secretory diarrhea
Fecal osmotic gap of secretory diarrhea
<50 mOsm/kg
Retention of water and electrolytes in the large intestine due to incomplete breakdown or reabsorption of food
Osmotic diarrhea
Fecal osmotic gap of osmotic diarrhea
> 75 mOsm/kg
Enhanced (hyper motility) or slow (constipation) motility
Altered motility
Sedi stain and KOVA stain are also known as
Sternheimer-Malbin stain
The ultimate goal of urinalysis is to ________and ________ while increasing productivity and standardization
Improve reproducibility and color discrimination
In UF-1000i analyazer, particles in the urine are categorized on the basis of: (FIFAS)
FORWARD SCATER
IMPEDANCE SIGNALS
FLUORESCENCE STAINING
ADAPTIVE CLUSTER ANALYSIS
SIDE SCATTER
UF1000i analyzer: specific for detection of bacteria
Side scatter
In UF1000i automated urinalysis analyzer, bacteria can be quantitated with the used of _____ and _____
Scattergram and histogram
Particles enumerated in UF1000i
Rbcs, WBCs, epithelial cells, hyaline casts , bacteria
Flagged particles in UF1000i
Nonhyaline (pathological) casts, crystals, small round cells, yeast, mucus, sperm
Based on a team concept involving personnel at all levels working together to achieve a final outcome of customer satisfaction on through implementation
Total quality management
Improving patient outcomes by providing construal quality care in a constantly changing health-care environment
Continuous health care environment (CQI)
QC of reagents, refractometer, check the temperatures of refrigerators and water baths is done
Daily
Disinfection of centrifuges, checking of pH and purity meter resistance of deionized water
Weekly basis
Diluents checked for contaminants
Biweekly
QC for bacterial count on deionized water
Monthly basis
Cytocentrifuge QC
Monthly basis
Calibration of centrifuges ( tachometer, strobe light, stopwatch)
3 or 6 months
Professional cleaning of the microscope is done
Annually